Quote from: rmaddy on September 30, 2017, 03:23:15 PMThey are reluctant to apply the results of studies on thromboembolic disease in pregnant women to the undeniably different population of transwomen on HRT.
There are several studies in transwomen and in men (XY, like us) with prostate cancer of an advanced aged showing that high doses and levels of estradiol did not increase risk, actually decreasing it in those men prescribed transdermal estradiol. In addition, several other studies in ciswomen on high dose/levels of estradiol showed that the risk did not increase (or negligibly on high dose oral estradiol) and in general, proved to be quite safe. Doctors are usually ignorant of such studies but I do my best to share these with them, in person or by email.
Given such similar responses to estradiol in different populations as regards to the incidence of thromboembolic events, one can assume the same would apply to progesterone.
QuoteThey would like to more convincing evidence that progesterone actually makes a discernible difference to trans patients.
It could be YEARS until we find out what the effects are in transpatients and most probably, these effects would also differ from one individual to another. Such studies may also never be undertaken. As such, given what we already know about progesterone in ciswomen and the anecdotal evidence in transwomen, one can be quite confident that it will very rarely lead to serious side-effects (and assuredly much less likely to do so compared to another progestogen prescribed to transwomen for decades, cyproterone acetate) so that this is not a good reason NOT to prescribe it.
Being so reluctant to prescribe it because of potential side-effects when non bio-identical drugs with a much riskier profile are routinely prescribed to transgender women worldwide makes absolutely no sense to me and seems quite strange.
QuoteWhat is the difficulty in accepting that the evidence regarding the risks and benefits of micronized progesterone is not especially deep?
The evidence so far gathered, as far as I am concerned, points to progesterone being quite safe relative to other drugs currently prescribed to transwomen and seems substantial enough. Just the fact that doctors are ready to prescribe other, riskier drugs to transwomen justifies at least trying to prescribe this seemingly, safer, bio-identical hormone to transwomen who may or may not benefit from it. Some transwomen have anecdotally reported benefits from it so why deprive other women who may potentially also benefit from it when the evidence in support of its safety seems, at least to me, pretty strong and substantial, even if only in ciswomen, pregnant or not. I doubt, for reasons stated above, the response in transwomen would be that much different as regards to potential serious side-effects.
Being this prudent about prescribing such a hormone, given all of the above, is irrational. Fortunately, more and more doctors share my view and do prescribe progesterone to their patients, if they ask for it.
